Impact of a provider-level incentive on smoking cessation treatment use: A secondary dataset analysis using administrative claims data and a cross-sectional survey in Japanese health check-up settings (N-EQUITY2203)

INTRODUCTION: Healthcare professionals are recommended to deliver smoking cessation support (SCS) to smokers. However, the effectiveness of provider-level financial incentives on smoker's behaviors, including the use of smoking cessation treatment (SCT), has been controversial. The aim of this observational study was to explore the association of a provider-level incentive to deliver a general lifestyle intervention, including SCS, with the smoker's use of SCT, and describe the current state of and barriers to delivering SCS at health check-up settings. METHODS: This observational study in a health check-up setting consisted of: 1) a retrospective, quasi-experimental study through secondary use of an administrative claims database between 2018 and 2020; and 2) a cross-sectional questionnaire survey in 2023. Change in the proportion of SCT users pre- and post-introduction of the incentive was analyzed using a claims database, employing a difference-in-difference (DID) approach using adjusted linear regression. To describe SCS at health check-up settings, a cross-sectional survey was sent to 26 health check-up centers that had received the incentives which requested a response from a healthcare professional at each center. Responses were presented as descriptive statistics. RESULTS: DID analysis using data for 126137 smokers revealed no significant change in the proportion of SCT users following introduction of the provider-level incentive (DID= -0.15; 95% CI: -1.09-0.80 per 1000 smokers, p=0.759). The survey, which received responses from 24 health check-up centers, showed that only 27% of these centers provided smokers with contact information for SCT services. Furthermore, 71% and 67% of centers cited a lack of resources and self-efficacy, respectively, as perceived barriers to the delivery of SCS. CONCLUSIONS: The provider-level incentive to deliver the general lifestyle intervention was not associated with SCT use in health check-up settings. Increasing SCT use may require strategies aimed at overcoming barriers to the delivery of SCS.